The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function

Boujemaa, Hajar; Yilmaz, Alaaddin; Robic, Boris; Koppo, Katrien; Claessen, Guido; Frederix, Ines; Dendale, Paul; Voeller, Heinz; van Loon, Luc J. C.; Hansen, Dominique

doi:10.1113/EP087407

Title

The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function

Author

Boujemaa, Hajar

Yilmaz, Alaaddin

Robic, Boris

Koppo, Katrien

Claessen, Guido

Frederix, Ines

Dendale, Paul

Voeller, Heinz

van Loon, Luc J. C.

Hansen, Dominique

Abstract

Suboptimal post-operative improvements in functional capacity are often observed after minimally invasive aortic valve replacement (mini-AVR). It remains to be studied how AVR affects the cardiopulmonary and skeletal muscle function during exercise to explain these clinical observations and to provide a basis for improved/tailored post-operative rehabilitation. Twenty two patients with severe aortic stenosis (AS) (aortic valve area (AVA) < 1.0 cm(2)) were preoperatively compared to 22 healthy controls during submaximal constant-workload endurance-type exercise for oxygen uptake (V-O2), carbon dioxide output (V-CO2), respiratory gas exchange ratio, expiratory volume (V-E), ventilatory equivalents for O-2 (V-E/V-O2) and CO2 (V-E/V-CO2), respiratory rate (RR), tidal volume (V-t), heart rate (HR), oxygen pulse (V-O2/HR), blood lactate, Borg ratings of perceived exertion (RPE) and exercise-onset V-O2 kinetics. These exercise tests were repeated at 5 and 21 days after AVR surgery (n = 14), along with echocardiographic examinations. Respiratory exchange ratio and ventilatory equivalents (V-E/V-O2 and V-E/V-CO2) were significantly elevated, V-O2 and V-O2/HR were significantly lowered, and exercise-onset V-O2 kinetics were significantly slower in AS patients vs. healthy controls (P < 0.05). Although the AVA was restored by mini-AVR in AS patients, V-E/V-O2 and V-E/V-CO2 further worsened significantly within 5 days after surgery, accompanied by elevations in Borg RPE, V-E and RR, and lowered V-t. At 21 days after mini-AVR, exercise-onset V-O2 kinetics further slowed significantly (P < 0.05). A decline in pulmonary function was observed early aftermini-AVRsurgery, which was followed by a decline in skeletal muscle function in the subsequent weeks of recovery. Therefore, a tailored rehabilitation programmeshould include training modalities for the respiratory and peripheral muscular system.

Language

English

Source (journal)

Experimental physiology. - Cambridge

Publication

Cambridge : 2019

ISSN

0958-0670

DOI

10.1113/EP087407

Volume/pages

104 :6 (2019) , p. 855-865